| NPI | 1689614893 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2082S0099X Plastic Surgery Plastic Surgery Within the Head and Neck (Licence: NV S2-40C) |
| Additional Taxonomies | 1223D0004X Dentist Dentist Anesthesiologist (Licence: NV SPG139-AA) |
| 204E00000X Oral & Maxillofacial Surgery (Licence: NV S2-40C) | |
| 207L00000X Anesthesiology (Licence: NV GA146) | |
| 208600000X Surgery (Licence: NV 9658) | |
| Enumeration Date | 2006-06-07 |
| Last Update Date | 2021-12-14 |